Low Back Pain Solutions Guide

Low back pain, also known as lumbago, is extremely common and will affect most of the population at one point or another. Intensity can range from slightly annoying to severe and debilitating. It’s actually the leading cause of disability worldwide!

The good news is that relief from low back pain is easily accessible and there is much you can do on your own. Understanding the root causes and pain generators will help determine the most effective solutions. There are many effective natural approaches for low back pain available. Let’s take a closer look.

What is Generating the Pain?

It’s good to first understand what pain is and which tissues are involved that actually generate low back pain.

Pain is a process. According to the International Association for the Study of Pain, pain is defined as such:

An unpleasant sensory and emotional experience associated with, or resembling that associated with, actual or potential tissue damage”.

It is an interpretation in the brain of signals sent from nerve endings relaying information about potential danger or damage. If a tissue is damaged, signals are sent to the brain and pain is elicited in order to prevent further damage. It’s like an alarm system designed to protect us. It is a subjective phenomenon and there are other factors that contribute to it such as stress, emotional state, thought patterns, genetics, etc.

There are different tissue structures in the lower back, or lumbar region, that can generate pain for various reasons. It's common to have multiple pain generators at the same time as these structures are closely situated together and when one tissue is irritated or injured, others close by will be too. Everything is connected.

Here are common pain generators of low back pain:

• Muscle and Connective Tissue Issues: The most common pain generating culprit of low back pain is soft tissue such as muscle, fascia/connective tissue, tendons, and ligaments. Muscle spasms, trigger points, or strains, ligament sprains, fascial tension and microscopic tears can all cause localized pain in the low back with varying intensities. Soft tissue pain can be caused by repetitive strain or overuse, trauma and injuries, or sedentary lifestyle.

• Disc Injuries: disc injuries include disc derangement, herniated discs and bulged discs. Intervertebral discs are cartilage structures between the vertebrae. When the outer fibers of the disc begin to tear, it is considered derangement. Sometimes when the fibers tear more, the gel-like substance inside the disc starts to push, or bulge outward. If it breaks through completely, it is considered herniated. This can cause inflammation and can be painful. The pain can be localized in the lower back but can also radiate to different parts of the body. Sometimes the herniated disc material can irritate the lumbar nerve roots and cause nerve issues such as sciatica.

• Joints: Joints are where two bones meet. The joints typically involved in low back pain are the facet joints and the sacroiliac joints (S.I. joints). The facet joints are joints between each vertebrae that allow for spinal movement. The sacroiliac joints are the joints between the sacrum, or the base of the spine, and the ilium, one of the pelvic bones. These joints can cause pain due to acute injuries, sprain, chronic repetitive overloading, and arthritic conditions.

• Nerves: The spinal nerve roots carry sensory and motor information to and from the brain and spinal cord and the rest of the body. Local cutaneous nerves of the lower back that supply the area with sensation can be irritated by acute injury or repetitive strain, causing local pain.

• Arthritis: Degenerative and inflammatory arthritic conditions can affect the lower back, leading to chronic pain and reduced mobility. Degenerative arthritis, also known as osteoarthritis, is much more common and develops over time from poor posture and repetitive strain. It can affect the joints in the lumbar spine which can eventually lead to stenosis. Inflammatory arthritis, such as rheumatoid arthritis, is an autoimmune condition that attacks joints on a chemical level and is not as common.

• Bone Fractures: Acute fractures in the vertebrae can occur as a result of traumatic injuries and will often cause localized acute pain. A condition called spondylolysis is a fairly common stress fracture of the pars interarticularis, a thin bone in the vertebrae. It is often caused by repetitive stress but can also be due to trauma.

• Skeletal Anomalies: Conditions such as a transitional vertebrae, where there is a deformity and an abnormal joint between the sacrum and the L5 vertebrae, can lead to back pain. This deformity is from birth and is considered a congenital anomaly. Congenital anomalies are often not associated with pain but in some cases can be.

• Osteoporosis: This condition weakens the density of bones, making them more susceptible to fractures.

• Spinal Infection: Infection in the vertebrae, called osteomyelitis, or in the spinal canal, can cause low back pain.

• Organ Referral and Internal Issues: Internal organ conditions can cause low back pain. Organs involved in low back pain are kidneys, prostate, uterus, pancreas, intestines, spleen, liver and gall bladder. Also, abdominal aortic aneurysm can refer pain to the lower back.

• Spinal Tumors: Cancerous (malignant) or non-cancerous (benign) tumors in the spine or lumbar region can cause low back pain.

It’s important to mention these more severe internal causes of low back pain, but keep in mind that the vast majority of cases are due to musculoskeletal issues such as muscle strains, fascial tension, disc issues and joint problems and although they can be debilitating, are not life threatening. In the case of a suspected infection, tumor, aneurysm or organ referral, immediate medical referral is required. This is why a proper evaluation and diagnosis is essential.

So what are the causes for these painful low back conditions?

There are often multiple causes of low back pain. Sometimes, like in the cases of acute trauma, it’s a distinct event that caused specific tissue damage and caused pain. In most cases though, there seems to be an accumulation over time of different factors that all play a role. Pain is usually triggered by something that seems insignificant like bending to pick up keys off the floor, putting a sock on, or even sneezing. But this triggering event is simply what pushed things over the edge after the effects had been building for a longer period of time.

It’s helpful to have a basic understanding of these mechanisms so that you can address the problem in the most comprehensive way. Here are the underlying causes that lead to low back pain of neuromusculoskeletal nature. Often it is a a combination of multiple causes so it's important to be able to look at the whole picture and address accordingly.

• Repetitive Strain: Repetitive activities, improper lifting technique, or sudden movements can lead to muscle strain and tension, distorted firing patterns, and stress in the joints and discs, resulting in injury and pain.

• Mechanical/Movement Imbalances: If soft tissue tension is causing restriction in movement, it can cause unnatural stress in other areas which can eventually lead to injury and pain. One of the most common examples of this I see in practice is restriction in the hips as an underlying cause of low back pain. When the hips are not moving adequately, forces are transferred above (towards the low back) and below (towards the knee), causing overloading over time. Another example is abnormal gait (asymmetries when walking) due to foot/ankle problems. If there is an imbalance in the foot, everything above can be affected negatively.

• Muscle Imbalances: When muscle firing patterns are out of balance, problems can occur locally and/or in other areas. Weakness or inhibition in stabilizing muscle groups, especially the core muscles, can lead to vulnerability in the lumbar spine and increased risk of injury. Tight or hypertonic muscles will lead to distortions in the mechanics of the pelvis and lumbar spine and eventually cause injury.

• Scar Tissue: Scar tissue from old injuries, repetitive strain, or surgical procedures can create distortions in the fascia which disrupt normal movement mechanics, microcirculation, energetic flow, and nerve communication. Over time this can lead to imbalances, injury and pain in different parts of the body, even away from the location of the scar.

• Poor Posture: Prolonged periods of sitting or standing in unbalanced positions can create tension in the muscles and fascia, leading to distortions and stress in the joints and discs. The most common is the forward flexed, or “hunched” posture which creates stress on the lumbar discs and connective tissues of the lower upper back. This is becoming more and more prevalent with the increase in sedentary lifestyles and longer hours in front of screens, smartphones and computer devices.

• Inactivity: A sedentary lifestyle can weaken muscles and lead to stiffness, making the tissues more vulnerable to injury.

• Emotional/Mental Stress: Mental/emotional stress can lead to fascial tension, muscle tightness and trigger points in the back, causing myofascial pain. Unresolved emotional issues and unhealthy mindset can also drive the pain process, making it harder to heal with approaches that only target the physical aspects.

• Injuries: Acute traumatic injuries, such as falls, car accidents, or sports injuries can cause tears, strains, sprains, disc injuries, fractures, and ongoing muscle and fascial tension and trigger points.

• Chronic Inflammatory Conditions: Conditions such as fibromyalgia, ankylosing spondylitis, and rheumatoid arthritis can directly cause low back pain.

• Neuroplastic Pain: This is a chronic form of pain in which the affected tissue has healed but the neurological pain pathways have been so conditioned to activate that the pain sensation persists even though there’s no longer a physical reason for it. It’s like a faulty or oversensitive alarm trigger. It can be difficult to treat because healthy movements that should not trigger pain still do. Mental stress and mindset play a large role in this. If a patient is doing everything right and more severe issues have been ruled out but pain persists, neuroplastic pain may be the culprit.

• Lifestyle: Obesity, poor diet, and smoking can contribute to chronic back pain due to poor circulation and increased systemic inflammation in the body. While these factors may be a direct cause, they can inhibit or slow the healing process when injuries occur.

• Dehydration and Nutritional Deficiencies: Inadequate hydration and/or nutrient deficiencies such as Vitamin D and magnesium can potentially contribute to low back pain.

How to Address Low Back Pain

As always, when dealing with pain, it’s important to determine the tissues involved and the cause. A good practitioner will take a thorough history, ask questions about your condition and your life, and listen attentively to you. In most cases, with that information and a thorough physical evaluation, they should have a good idea of what’s happening and be able to determine a preliminary plan of action.

In some cases, further diagnostic workup may be required, including imaging (x-ray, MRI, CT scan), EMG/NCV exam, blood chemistry testing, etc. If red flags are present that may indicate more severe or ominous conditions, immediate medical referral is warranted.

The goal of an effective natural approach is to find the imbalance or dysfunction and correct it at its root cause, or as close to it as possible. If something is not moving enough, restore movement. If something is not strong enough, strengthen it. If there’s a lack of coordination, then work on improving coordination.

And always ask, “Why?” Why is there weakness? Why is there restriction? Why is this happening? What is my body trying to tell me by activating the pain process? What is it that I’m doing or have done that’s caused this? And then how can I change the behavior or habit to make sure it doesn’t happen again?

Every individual situation is different, but in most cases of musculoskeletal low back pain, the following basic treatment principles will apply. The underlying condition will indicate specific details and focal points, but the foundational concepts are the same.

• Believe you will overcome and resolve the pain. It’s extremely important to keep a healthy mindset about your health and your body’s natural ability to heal.

• Implement spine-sparing exercises and habits such as McGill microbreak and hip hinge.

• Walking, especially in the early morning upon waking, is one of the best exercises. Optimal distance and time will vary based on the individual situation and tolerance levels.

• Improve hip mobility with soft tissue techniques such as Fascial Manipulation and Active Release Techniques (A.R.T.). Releasing tension from the fascia and muscles will allow the joint to move easier, reducing stress on the lumbar spine and sacroiliac joints.

• Release fascial tension with the above soft tissue techniques throughout the lumbar region and other regions of the body that may be contributing to the problem.

• Improve breathing pattern to engage the diaphragm, which is part of the core muscle group.

• Stabilize the spine by conditioning the core muscles with exercises such as Stuart McGill’s Big Three (bird dog, curl up, side bridge) and neurosensory balance training.

• Reduce inflammation by avoiding inflammatory foods such as processed foods with unnatural additives, added sugar. Consider possible supplementation with vitamin D, magnesium, omega 3 fatty acids, proteolytic enzymes and anti-inflammatory herbs if appropriate. Consult with a professional before adding supplements especially if on prescription medication.

• Acupuncture is extremely helpful for pain control, regulating the nervous system, improving nerve function, improving microcirculation, releasing fascial tension and reducing spasm and trigger point tension in the muscles.

• Chiropractic adjustments can help to restore movement in dysfunctional spinal (and extremity) joints, helping to relax tense muscles and fascia, improve nerve function, and significantly reduce pain.

• Heat therapy can help to relax tense muscles, alleviate pain and help facilitate movement of blood and fluids.

• Improve ergonomics by assessing work place, home environment, car seat, etc. Modify your environment to best promote good posture, symmetry, and mechanics.

• Regular low-impact dynamic exercise such as swimming, yoga, tai chi, pilates can strengthen the spine stabilizing muscles, improve flexibility and mobility, improve coordination, and reduce the risk of recurrence. Type of exercise and intensity levels will of course vary depending on individual situations. Working with a competent instructor is always recommended.

• Reduce and manage stress as much as possible. Pay attention to chronic daily stressors and make changes accordingly. Mindfulness techniques can be very helpful. Consider major stressful events that may have happened around the time of pain onset. Seek professional help to work through this if necessary.

• Address neuroplastic pain if present with Pain Reprocessing Therapy or other forms of therapy that can help target the underlying emotional causes of chronic pain.
  

In some severe stubborn cases that don’t respond quickly to natural approaches, medical referral and interventions such oral anti-inflammatory medication and/or injections can help to break the pain cycle. Surgical interventions are usually only warranted in extreme situations such as severe neurological deficit like loss of bladder/bowel control and/or muscle atrophy is present, unstable vertebral fracture, or in the case of a tumor or infection.

Conclusion

While low back pain is the most common cause of disability worldwide, it does not have to take over your life. With the right knowledge, understanding and support, it can be managed and overcome with natural means in the vast majority of cases.

Healing is an active process, so the more proactive you are, the better your results will be.

As there are many possibilities with low back pain, understanding the affected tissues and causes is of the utmost importance. With this understanding, you can then work on targeted solutions to help your body heal as efficiently as possible. It’s always a good idea to work with a knowledgable professional to help evaluate, diagnose and guide you in this process.

Remember, your body is capable of healing. You have more power than are often lead to believe when it comes to your health, so take responsibility, take action, and keep getting better!